Power and control in intercultural communication

There is a complex interaction between power and communication: power relationships between the participants in an encounter play a crucial, but often unacknowledged, role in communication and communication itself has an important influence on the dynamics of power between groups and individuals.

It is also crucial to consider communication in the context of the power relations operating within the health system as a whole. An understanding of the relationship between communication and power is not often reflected, however, in practice.

An important theme to emerge from this study was the influence of location of control on communication in terms of management of interactions, access to information and decision making about treatment.

One example in which the location of control seriously compromises communication is in the dominance of Western biomedical discourse systems and the marginalisation or exclusion of Indigenous discourse systems. In each of the renal encounters, control over every aspect of the communication was located primarily with the staff, as is the case in many health care settings:

• the time, place, participants, goals,agendas, structure, topics, and the language as well as the forms and styles of discourse used, are controlled by the staff and generally accommodated by the patients, as much as they are able to do this
• Western biomedical perspectives, knowledge and priorities are privileged over those of Indigenous users (and providers)
• health care interactions are structured by a compartmentalised approach based on professional roles and boundaries (staff-centered rather than patient-centred)

This serious imbalance of power and its consequences is generally unrecognised and/or uncontested.